Provider Demographics
NPI:1801840137
Name:SHAFT, CHRISTINE LEBLANC (PT)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINE
Middle Name:LEBLANC
Last Name:SHAFT
Suffix:
Gender:F
Credentials:PT
Other - Prefix:MS
Other - First Name:CHRISTINE
Other - Middle Name:KAY
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PT
Mailing Address - Street 1:9097 E DESERT COVE
Mailing Address - Street 2:SUITE 110
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85260
Mailing Address - Country:US
Mailing Address - Phone:480-837-2595
Mailing Address - Fax:480-837-2773
Practice Address - Street 1:16838 E PALISADES BLVD
Practice Address - Street 2:BUILDING B
Practice Address - City:FOUNTAIN HILLS
Practice Address - State:AZ
Practice Address - Zip Code:85268-3845
Practice Address - Country:US
Practice Address - Phone:480-837-2595
Practice Address - Fax:480-837-2773
Is Sole Proprietor?:No
Enumeration Date:2006-05-20
Last Update Date:2022-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ2441225100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225100000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersPhysical Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ27932Medicare PIN
AZ27932Medicare ID - Type Unspecified